Search results for: Kennedy Efosa Ehimwenma
34 Applied Complement of Probability and Information Entropy for Prediction in Student Learning
Authors: Kennedy Efosa Ehimwenma, Sujatha Krishnamoorthy, Safiya Al‑Sharji
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The probability computation of events is in the interval of [0, 1], which are values that are determined by the number of outcomes of events in a sample space S. The probability Pr(A) that an event A will never occur is 0. The probability Pr(B) that event B will certainly occur is 1. This makes both events A and B a certainty. Furthermore, the sum of probabilities Pr(E₁) + Pr(E₂) + … + Pr(Eₙ) of a finite set of events in a given sample space S equals 1. Conversely, the difference of the sum of two probabilities that will certainly occur is 0. This paper first discusses Bayes, the complement of probability, and the difference of probability for occurrences of learning-events before applying them in the prediction of learning objects in student learning. Given the sum of 1; to make a recommendation for student learning, this paper proposes that the difference of argMaxPr(S) and the probability of student-performance quantifies the weight of learning objects for students. Using a dataset of skill-set, the computational procedure demonstrates i) the probability of skill-set events that have occurred that would lead to higher-level learning; ii) the probability of the events that have not occurred that requires subject-matter relearning; iii) accuracy of the decision tree in the prediction of student performance into class labels and iv) information entropy about skill-set data and its implication on student cognitive performance and recommendation of learning.Keywords: complement of probability, Bayes’ rule, prediction, pre-assessments, computational education, information theory
Procedia PDF Downloads 16033 The Ebola Virus Disease and Its Outbreak in Nigeria
Authors: Osagiede Efosa Kelvin
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The Ebola virus disease (EVD); also Ebola hemorrhagic fever, is a disease of humans and other primates caused by Ebola viruses. Signs and symptoms typically start between two days and three weeks after contracting the virus as a fever, sore throat, muscle pain, and headaches. Then, vomiting, diarrhoea and rash usually follow, along with decreased function of the liver and kidneys. At this time, some people begin to bleed both internally and externally. The first death in Nigeria was reported on 25 July 2014: a Liberian-American with Ebola flew from Liberia to Nigeria and died in Lagos soon after arrival. As part of the effort to contain the disease, possible contacts were monitored –353 in Lagos and 451 in Port Harcourt On 22 September, the World Health Organisation reported a total of 20 cases, including eight deaths. The WHO's representative in Nigeria officially declared Nigeria Ebola-free on 20 October after no new active cases were reported in the follow-up contact. This paper looks at the Ebola Virus in general and the measures taken by Nigeria to combat its spread.Keywords: Ebola virus, hemorrhagic fever, Nigeria, outbreak
Procedia PDF Downloads 50132 Algorithm for Predicting Cognitive Exertion and Cognitive Fatigue Using a Portable EEG Headset for Concussion Rehabilitation
Authors: Lou J. Pino, Mark Campbell, Matthew J. Kennedy, Ashleigh C. Kennedy
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A concussion is complex and nuanced, with cognitive rest being a key component of recovery. Cognitive overexertion during rehabilitation from a concussion is associated with delayed recovery. However, daily living imposes cognitive demands that may be unavoidable and difficult to quantify. Therefore, a portable tool capable of alerting patients before cognitive overexertion occurs could allow patients to maintain their quality of life while preventing symptoms and recovery setbacks. EEG allows for a sensitive measure of cognitive exertion. Clinical 32-lead EEG headsets are not practical for day-to-day concussion rehabilitation management. However, there are now commercially available and affordable portable EEG headsets. Thus, these headsets can potentially be used to continuously monitor cognitive exertion during mental tasks to alert the wearer of overexertion, with the aim of preventing the occurrence of symptoms to speed recovery times. The objective of this study was to test an algorithm for predicting cognitive exertion from EEG data collected from a portable headset. EEG data were acquired from 10 participants (5 males, 5 females). Each participant wore a portable 4 channel EEG headband while completing 10 tasks: rest (eyes closed), rest (eyes open), three levels of the increasing difficulty of logic puzzles, three levels of increasing difficulty in multiplication questions, rest (eyes open), and rest (eyes closed). After each task, the participant was asked to report their perceived level of cognitive exertion using the NASA Task Load Index (TLX). Each participant then completed a second session on a different day. A customized machine learning model was created using data from the first session. The performance of each model was then tested using data from the second session. The mean correlation coefficient between TLX scores and predicted cognitive exertion was 0.75 ± 0.16. The results support the efficacy of the algorithm for predicting cognitive exertion. This demonstrates that the algorithms developed in this study used with portable EEG devices have the potential to aid in the concussion recovery process by monitoring and warning patients of cognitive overexertion. Preventing cognitive overexertion during recovery may reduce the number of symptoms a patient experiences and may help speed the recovery process.Keywords: cognitive activity, EEG, machine learning, personalized recovery
Procedia PDF Downloads 21931 The Effectiveness of Rebranding as a Comparative Study of Ghanaian Business Using the Principles of Corporate Rebranding
Authors: Kennedy Gbenu, Richmond Kweku Frempong
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Rebranding has become a very important strategic tool for companies wanting to succeed in the ever competitive business world using the principles of rebranding Moisescu. Two businesses in Ghana (Ghana Commercial Bank and Vodafone Ghana) have been used to ascertain how rebranding of these organizations was done using the principles in their effort to rebrand themselves and to stay relevant. A secondary research mainly on literature surrounding rebranding, official websites of the organizations under study have also been used extensively. After a basic comparative study undertaken two firms (GCB and VODAFONE) seems to be using the first three principles and reaping from it as provided by Moisescu. This goes to show that rebranding should not be done in vacuum but should be guided by such principles so as to achieve the full potential of any kind of investments made.Keywords: brands, corporate branding, innovation, case studies
Procedia PDF Downloads 39630 We Wonder If They Mind: An Empirical Inquiry into the Narratological Function of Mind Wandering in Readers of Literary Texts
Authors: Tina Ternes, Florian Kleinau
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The study investigates the content and triggers of mind wandering (MW) in readers of fictional texts. It asks whether readers’ MW is productive (text-related) or unproductive (text-unrelated). Methodologically, it bridges the gap between narratological and data-driven approaches by utilizing a sentence-by-sentence self-paced reading paradigm combined with thought probes in the reading of an excerpt of A. L. Kennedy’s “Baby Blue”. Results show that the contents of MW can be linked to text properties. We validated the role of self-reference in MW and found prediction errors to be triggers of MW. Results also indicate that the content of MW often travels along the lines of the text at hand and can thus be viewed as productive and integral to interpretation.Keywords: narratology, mind wandering, reading fiction, meta cognition
Procedia PDF Downloads 8129 Effects of Drying Temperatures on the Qualitative and Quantitative Phytochemicals of Aqueous Extracts If the Calyces of Hibiscus Sabdariffa
Authors: John O. Efosa, S. Egielewa, M. A. Azeke
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Hibiscus sabdariffa (Hs) is known for its delicacy and also for medicinal properties. The flower calyces are usually sun- or oven-dried after harvesting. There are unverified claims that calyces dried at lower temperatures have better medicinal potentials than those dried at higher temperatures. The present work, therefore, aimed to study the effects of drying temperatures on the photochemical composition and antioxidant potential of aqueous extracts of the calyces of Hs. The calyces were dried at different temperatures (freeze-drying at -580C, drying at 300C, 400C, and 500 C.) respectively to constant weight. Samples (25 g) of dried calyces from each drying temperatures were weighed and placed in clean conical flasks and extracted; each was used for the analysis. Validated analytical assays were used for the determination of the different Phytochemicals. From the results obtained, it was observed that drying at 30°C resulted in the highest retention of total phenols, total flavonoids, tannins, alkaloids and saponins. Using the Inhibition Concentration values (IC50), some antioxidant parameters were found to follow the same trend as the earlier mentioned phytochemicals. Drying at 30°C resulted in the highest retention of DPPH Radical Scavenging Activity, Ferric Reducing Antioxidant Potential (FRAP), Nitrite radical scavenging Activity, 2, 2-azinobis-3-ethylbenzotiazoline-6-sulfonic acid (ABTS) radical scavenging activity There were, however, significant reductions in vitamin C and oxalate contents as the drying temperature increased (P < 0.05). From the results, it recommended that the calyces of Hibiscus sabdariffa be dried at 30°C in order to optimally elicit its medicinal potentials.Keywords: antioxidant, drying temperature, hibiscus sabdariffa, phytochemicals, quantitative
Procedia PDF Downloads 16528 A Review on Intelligent Systems for Geoscience
Authors: R Palson Kennedy, P.Kiran Sai
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This article introduces machine learning (ML) researchers to the hurdles that geoscience problems present, as well as the opportunities for improvement in both ML and geosciences. This article presents a review from the data life cycle perspective to meet that need. Numerous facets of geosciences present unique difficulties for the study of intelligent systems. Geosciences data is notoriously difficult to analyze since it is frequently unpredictable, intermittent, sparse, multi-resolution, and multi-scale. The first half addresses data science’s essential concepts and theoretical underpinnings, while the second section contains key themes and sharing experiences from current publications focused on each stage of the data life cycle. Finally, themes such as open science, smart data, and team science are considered.Keywords: Data science, intelligent system, machine learning, big data, data life cycle, recent development, geo science
Procedia PDF Downloads 13427 Biosorption of Cu (II) and Zn (II) from Real Wastewater onto Cajanus cajan Husk
Authors: Mallappa A. Devani, John U. Kennedy Oubagaranadin, Basudeb Munshi
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In this preliminary work, locally available husk of Cajanus cajan (commonly known in India as Tur or Arhar), a bio-waste, has been used in its physically treated and chemically activated form for the removal of binary Cu (II) and Zn(II) ions from the real waste water obtained from an electroplating industry in Bangalore, Karnataka, India and from laboratory prepared binary solutions having almost similar composition of the metal ions, for comparison. The real wastewater after filtration and dilution for five times was used for biosorption studies at the normal pH of the solutions at room temperature. Langmuir's binary model was used to calculate the metal uptake capacities of the biosorbents. It was observed that Cu(II) is more competitive than Zn(II) in biosorption. In individual metal biosorption, Cu(II) uptake was found to be more than that of the Zn(II) and a similar trend was observed in the binary metal biosorption from real wastewater and laboratory prepared solutions. FTIR analysis was carried out to identify the functional groups in the industrial wastewater and EDAX for the elemental analysis of the biosorbents after experiments.Keywords: biosorption, Cajanus cajan, multi metal remediation, wastewater
Procedia PDF Downloads 38626 Perceived Causes of Mathematics Phobia Amongst Senior Secondary School Students in Yenagoa Metropolis, Bayelsa State, Nigeria
Authors: Iniye Irene Wodi, Kennedy B. Gibson
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Students’ poor performance in mathematics in both internal and external examinations has been a source of concern to researchers in Nigeria. The cause of this has been attributed to both teachers and students. To this end, this study sought to find out students’ perceptions of teachers’ attributes as a cause of mathematics phobia among secondary school students in Bayelsa State Nigeria. The population of the study comprised of all students of senior secondary schools in Yenagoa metropolis. A sample of 120 students was drawn from this population using clustering and simple random sampling techniques. The instrument for data collection was a researcher constructed questionnaire titled Mathematics Phobia Questionnaire (MPQ). Data were analysed, and the results revealed that students perceived teachers’ attributes such as methods and styles of teaching, difficulty in communication, etc. as causes of mathematics phobia among students in senior secondary schools in Bayelsa State. Based on the result, it was therefore recommended that mathematics teachers should be retrained periodically in order to learn new and innovative ways of teaching mathematics to prevent its phobia among students.Keywords: mathematics phobia, teacher attributes, teaching method, teaching style
Procedia PDF Downloads 11125 Heterogeneous Catalytic Hydroesterification of Soybean Oil to Develop a Biodiesel Formation
Authors: O. Mowla, E. Kennedy, M. Stockenhuber
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Finding alternative renewable resources of energy has attracted the attentions in consequence of limitation of the traditional fossil fuel resources, increasing of crude oil price and environmental concern over greenhouse gas emissions. Biodiesel (or Fatty Acid Methyl Esters (FAME)), an alternative energy source, is synthesised from renewable sources such as vegetable oils and animal fats and can be produced from waste oils. FAME can be produced via hydroesterification of oils. The process involves two stages. In the first stage of this process, fatty acids and glycerol are being obtained by hydrolysis of the feed stock oil. In the second stage, the recovered fatty acids are then esterified with an alcohol to methyl esters. The presence of a catalyst accelerates the rate of the hydroesterification reaction of oils. The overarching aim of this study is to find the effect of using zeolite as a catalyst in the heterogeneous hydroesterification of soybean oil. Both stages of the catalytic hydroesterification of soybean oil had been conducted at atmospheric and high-pressure conditions using reflux glass reactor and Parr reactor, respectively. The effect of operating parameters such as temperature and reaction time on the overall yield of biodiesel formation was also investigated.Keywords: biodiesel, heterogeneous catalytic hydroesterification, soybean oil, zeolite
Procedia PDF Downloads 43224 Investigation of the Cyclic Response of Mudrock
Authors: Shaymaa Kennedy, Sam Clark, Paul Shaply
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With the upcoming construction of high-speed rail HS2 in the UK, a number of issues surrounding the construction technology and track design need to be answered. In this paper performance of subsoil subjected to dynamic loads were studied. The material of study is Mudrock backfill, a weak prevalent rock which response under indicative loading of high-speed rail line is unknown. This paper aims to investigate the use of different track types and the influence they will have on the underlying soil, in order to evaluate the behaviour of it. Ballstless track is a well-established concept in Europe, and the investigation the benefit of the form of construction due to its known savings in maintenance costs. Physical test using a triaxial cyclic loading machine was conducted to assess the expected mechanical behaviour of mudrock under a range of dynamic loads which could be generated beneath different track constructions. Some further parameters are required to frame the problem including determining the stress change with depth and cyclic response are vital to determine the residual plastic strain which is a major concern. In addition, Stress level is discussed in this paper, which are applied to recreate conditions of soil in the laboratory. Results indicate that stress levels are highly influential on the performance of soil at shallower depth and become insignificant with increasing depth.Keywords: stress level, dynamic load, residual plastic strain, high speed railway
Procedia PDF Downloads 24523 Selection of Soil Quality Indicators of Rice Cropping Systems Using Minimum Data Set Influenced by Imbalanced Fertilization
Authors: Theresa K., Shanmugasundaram R., Kennedy J. S.
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Nutrient supplements are indispensable for raising crops and to reap determining productivity. The nutrient imbalance between replenishment and crop uptake is attempted through the input of inorganic fertilizers. Excessive dumping of inorganic nutrients in soil cause stagnant and decline in yield. Imbalanced N-P-K ratio in the soil exacerbates and agitates the soil ecosystems. The study evaluated the fertilization practices of conventional (CFs), organic and Integrated Nutrient Management system (INM) on soil quality using key indicators and soil quality indices. Twelve rice farming fields of which, ten fields were having conventional cultivation practices, one field each was organic farming based and INM based cultivated under monocropping sequence in the Thondamuthur block of Coimbatore district were fixed and properties viz., physical, chemical and biological were studied for four cropping seasons to determine soil quality index (SQI). SQI was computed for conventional, organic and INM fields. Comparing conventional farming (CF) with organic and INM, CF was recorded with a lower soil quality index. While in organic and INM fields, the higher SQI value of 0.99 and 0.88 respectively were registered. CF₄ received with a super-optimal dose of N (250%) showed a lesser SQI value (0.573) as well as the yield (3.20 t ha⁻¹) and the CF6 which received 125 % N recorded the highest SQI (0.715) and yield (6.20 t ha⁻¹). Likewise, most of the CFs received higher N beyond the level of 125 % except CF₃ and CF₉, which recorded lower yields. CFs which received super-optimal P in the order of CF₆&CF₇>CF₁&CF₁₀ recorded lesser yields except for CF₆. Super-optimal K application also recorded lesser yield in CF₄, CF₇ and CF₉.Keywords: rice cropping system, soil quality indicators, imbalanced fertilization, yield
Procedia PDF Downloads 15722 The Impact of Artesunate-Amodiaquine on Schistosoma mansoni Infection among Children Infected by Plasmodium in Rural Area of Lemfu, Kongo Central, Democratic Republic of the Congo
Authors: Mbanzulu Kennedy, Zanga Josue, Wumba Roger
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Malaria and schistosomiasis remain life-threatening public health problems in sub-Saharan Africa. The infection pattern related to age indicates that preschool and school-age children are at the highest risk of malaria and schistosomiasis. Both parasitic infections, separately or combined, may have negative impacts on the haemoglobin concentration levels. The existing data revealed that artemisinin derivatives commonly used to cure malaria present also in antischistosomal activities. The current study investigated the impact of Artesunate-Amodiaquine (AS-AQ) on schistosomiasis when administered to treat malaria in rural area of Lemfu, DRC. A prospective longitudinal study including 171 coinfected children screened for anaemia, Schistosoma mansoni, and Plasmodium falciparum infections. The egg reduction rate and haemoglobin concentration were assessed four weeks after the treatment with AS-AQ, of all coinfected children of this series. One hundred and twenty-five (74.4%) out of 168 coinfected children treated and present during the assessment were found stool negative for S. mansoni eggs. Out of 43 (25.6%) children who remained positives, 37 (22%) showed a partial reduction of eggs amount, and no reduction was noted in 3.6% of coinfected. The mean of haemoglobin concentration and the prevalence of anaemia were, respectively, 10.74±1.5g/dl , 11.2±1.3g/dl, and 64.8%, 51.8%, respectively, before and after treatment, p<0.001. The AS-AQ commonly used against Plasmodium allowed curing S. mansoni in coinfected children and increasing the Hb level. For the future, the randomized and multicentric clinical trials are needed for a better understanding of the effectiveness of AS-AQ against Schistosoma spp. The trial registration number was 3487183.Keywords: paludisme, schistosomiase, as-aq, enfants lemfu
Procedia PDF Downloads 10121 Comparing the Embodied Carbon Impacts of a Passive House with the BC Energy Step Code Using Life Cycle Assessment
Authors: Lorena Polovina, Maddy Kennedy-Parrott, Mohammad Fakoor
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The construction industry accounts for approximately 40% of total GHG emissions worldwide. In order to limit global warming to 1.5 degrees Celsius, ambitious reductions in the carbon intensity of our buildings are crucial. Passive House presents an opportunity to reduce operational carbon by as much as 90% compared to a traditional building through improving thermal insulation, limiting thermal bridging, increasing airtightness and heat recovery. Up until recently, Passive House design was mainly concerned with meeting the energy demands without considering embodied carbon. As buildings become more energy-efficient, embodied carbon becomes more significant. The main objective of this research is to calculate the embodied carbon impact of a Passive House and compare it with the BC Energy Step Code (ESC). British Columbia is committed to increasing the energy efficiency of buildings through the ESC, which is targeting net-zero energy-ready buildings by 2032. However, there is a knowledge gap in the embodied carbon impacts of more energy-efficient buildings, in particular Part 3 construction. In this case study, life cycle assessments (LCA) are performed on Part 3, a multi-unit residential building in Victoria, BC. The actual building is not constructed to the Passive House standard; however, the building envelope and mechanical systems are designed to comply with the Passive house criteria, as well as Steps 1 and 4 of the BC Energy Step Code (ESC) for comparison. OneClick LCA is used to perform the LCA of the case studies. Several strategies are also proposed to minimize the total carbon emissions of the building. The assumption is that there will not be significant differences in embodied carbon between a Passive House and a Step 4 building due to the building envelope.Keywords: embodied carbon, energy modeling, energy step code, life cycle assessment
Procedia PDF Downloads 14720 Managing Physiological and Nutritional Needs of Rugby Players in Kenya
Authors: Masita Mokeira, Kimani Rita, Obonyo Brian, Kwenda Kennedy, Mugambi Purity, Kirui Joan, Chomba Eric, Orwa Daniel, Waiganjo Peter
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Rugby is a highly intense and physical game requiring speed and strength. The need for physical fitness therefore cannot be over-emphasized. Sports are no longer about lifting weights so as to build muscle. Most professional teams are investing much more in the sport in terms of time, equipment and other resources. To play competitively, Kenyan players may therefore need to complement their ‘home-grown’ and sometimes ad-hoc training and nutrition regimes with carefully measured strength and conditioning, diet, nutrition, and supplementation. Nokia Research Center and University of Nairobi conducted an exploratory study on needs and behaviours surrounding sports in Africa. Rugby being one sport that is gaining ground in Kenya was selected as the main focus. The end goal of the research was to identify areas where mobile technology could be used to address gaps, challenges and/or unmet needs. Themes such as information gap, social culture, growth, and development, revenue flow, and technology adoption among others emerged about the sport. From the growth and development theme, it was clear that as rugby continues to grow in the country, teams, coaches, and players are employing interesting techniques both in training and playing. Though some of these techniques are indeed scientific, those employing them are sometimes not fully aware of their scientific basis. A further case study on sports science in rugby in Kenya focusing on physical fitness and nutrition revealed interesting findings. This paper discusses findings on emerging adoption of techniques in managing physiological and nutritional needs of rugby players across different levels of rugby in Kenya namely high school, club and national levels.Keywords: rugby, nutrition, physiological needs, sports science
Procedia PDF Downloads 38619 Smoking and Alcohol Consumption Predicts Multiple Head and Neck Cancers
Authors: Kim Kennedy, Daren Gibson, Stephanie Flukes, Chandra Diwakarla, Lisa Spalding, Leanne Pilkington, Andrew Redfern
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Introduction: It is well known that patients with Head and Neck Cancer (HNC) are at increased risk of subsequent head and neck cancers due to various aetiologies. Aim: We sought to determine the factors contributing to an increased risk of subsequent HNC primaries, and also to evaluate whether Aboriginal patients are at increased risk. Methods: We performed a retrospective cohort analysis of 320 HNC patients from a single centre in Western Australia, identifying 80 Aboriginal patients and 240 non-Aboriginal patients matched on a 1:3 ratio by site, histology, rurality, and age. We collected patient data including smoking and alcohol consumption, tumour and treatment data, and data on subsequent HNC primaries. Results: A subsequent HNC primary was seen in 37 patients (11.6%) overall. There was no significant difference in the rate of second primary HNCs between Aboriginal patients (12.5%) and nonAboriginal patients (11.2%) (p=0.408). Subsequent HNCs, were strongly associated with smoking and alcohol consumption however, with 95% of patients with a second primary being ever-smokers, and 54% of patients with a second primary having a history of excessive alcohol consumption. In the 37 patients with multiple HNC primaries, there were a total of 57 HNCs, with 29 patients having two primaries, six patients having 3 HNC primaries, one patient with four, and one with six. 54 out of the 57 cancers were in ever smokers (94.7%). There were only two multiple HNC primaries in a never smoker, non-drinker, and these cases were of unknown etiology with HPV/p16 status unknown in both cases. In the whole study population, there were 32 HPV-positive HNCs, and 67 p16-positive HNCs, with only two 2 nd HNCs in a p16-positive case, giving a rate of 3% in the p16+ population, which is actually much lower than the rate of second primaries seen in the overall population (11.6%), and was highest in the p16-negative population (15.7%). This suggests that p16-positivity is not a strong risk factor for subsequent primaries, and in fact p16-negativity appeared to be associated with increased risk, however this data is limited by the large number of patients without documented p16 status (45.3% overall, 12% for oropharyngeal, and 59.6% for oral cavity primaries had unknown p16 status). Summary: Subsequent HNC primaries were strongly associated with smoking and alcohol excess. Second and later HNC primaries did not appear to occur at increased rates in Aboriginal patients compared with non-Aboriginal patients, and p16-positivity did not predict increased risk, however p16-negativity was associated with an increased risk of subsequent HNCs.Keywords: head and neck cancer, multiple primaries, aboriginal, p16 status, smoking, alcohol
Procedia PDF Downloads 6818 Aboriginal Head and Neck Cancer Patients Have Different Patterns of Metastatic Involvement, and Have More Advanced Disease at Diagnosis
Authors: Kim Kennedy, Daren Gibson, Stephanie Flukes, Chandra Diwakarla, Lisa Spalding, Leanne Pilkington, Andrew Redfern
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Introduction: The mortality gap in Aboriginal Head and Neck Cancer is well known, but the reasons for poorer survival are not well established. Aim: We aimed to evaluate the locoregional and metastatic involvement, and stage at diagnosis, in Aboriginal compared with non-Aboriginal patients. Methods: We performed a retrospective cohort analysis of 320 HNC patients from a single centre in Western Australia, identifying 80 Aboriginal patients and 240 non-Aboriginal patients matched on a 1:3 ratio by sites, histology, rurality, and age. We collected data on the patient characteristics, tumour features, regions involved, stage at diagnosis, treatment history, and survival and relapse patterns, including sites of metastatic and locoregional involvement. Results: Aboriginal patients had a significantly higher incidence of lung metastases (26.3% versus 13.7%, p=0.009). Aboriginal patients also had a numerically but non-statistically significant higher incidence of thoracic nodal involvement (10% vs 5.8%) and malignant pleural effusions (3.8% vs 2.5%). Aboriginal patients also had a numerically but not statistically significantly higher incidence of adrenal and bony involvement. Interestingly, non-Aboriginal patients had an increased rate of cutaneous (2.1% vs 0%) and liver metastases (4.6% vs 2.5%) compared with Aboriginal patients. In terms of locoregional involvement, Aboriginal patients were more than twice as likely to have contralateral neck involvement (58.8% vs 24.2%, p<0.00001), and 30% more likely to have ipsilateral neck lymph node involvement (78.8% vs 60%, p=0.002) than non-Aboriginal patients. Aboriginal patients had significantly more advanced disease at diagnosis (p=0.008). Aboriginal compared with non-Aboriginal patients were less likely to present with stage I (7.5% vs 22.5%), stage II (11.3% vs 13.8%), or stage III disease (13.8% vs 17.1%), and more likely to present with more advanced stage IVA (42.5% vs 34.6%), stage IVB (15% vs 7.1%), or stage IVC (10% vs 5%) disease (p=0.008). Number of regions of disease involvement was higher in Aboriginal patients (median 3, mean 3.64, range 1-10) compared with non-Aboriginal patients (median 2, mean 2.80, range 1-12). Conclusion: Aboriginal patients had a significantly higher incidence of lung metastases, and significantly more frequent involvement of ipsilateral and contralateral neck lymph nodes. Aboriginal patients also had significantly more advanced disease at presentation with a higher stage at diagnosis. We are performing further analyses to investigate explanations for these findings.Keywords: head and neck cancer, Aboriginal, metastases, locoregional, pattern of relapse, sites of disease
Procedia PDF Downloads 6817 The Representations of Protesters in the UK National Daily Press: Pro- And Anti- Brexit Demonstrations 2016-2019
Authors: Charlotte-Rose Kennedy
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In a political climate divided by Brexit, it is crucial to be critical of the press, as it is the apparatus which political authorities use to impose their laws and shape public opinion. Although large protests have the power to shake and disrupt policy-making by making it difficult for governments to ignore their goals, the British press historically constructs protesters as delegitimate, deviant, and criminal, which could limit protests’ credibility and democratic power. This paper explores how the remain supporting daily UK press (The Mirror, Financial Times, The Independent, The Guardian) and the leave supporting daily UK press (The Daily Mail, The Daily Star, The Sun, The Express, The Telegraph) discursively constructed every pro- and anti-Brexit demonstration from 2016 to 2019. 702 instances of the terms ‘protester’, ‘protesters’, ‘protestor’ and ‘protestors’ were analyzed through both transitivity analysis and critical discourse analysis. This mixed-methods approach allowed for the analysis of how the UK press perpetuated and upheld social ideologies about protests through their specific grammatical and language choices. The results of this analysis found that both remain and leave supporting press utilized the same discourses to report on protests they oppose and protests they support. For example, the remain backing The Mirror used water metaphors regularly associated with influxes of refugees and asylum seekers to support the protesters on the remain protest ‘Final Say’, and oppose the protesters on the leave protest ‘March to Leave’. Discourses of war, violence, and victimhood are also taken on by both sides of the press Brexit debate and are again used to support and oppose the same arguments. Finally, the paper concludes that these analogous discourses do nothing to help the already marginalized social positions of protesters in the UK and could potentially lead to reduced public support for demonstrations. This could, in turn, facilitate the government in introducing increasingly restrictive legislation in relation to freedom of assembly rights, which could be detrimental to British democracy.Keywords: Brexit, critical discourse analysis, protests, transitivity analysis, UK press
Procedia PDF Downloads 17916 Analysing the Creative Evolution of the Beatles
Authors: David Mason-Cox
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Existing academic analyses of The Beatles cover a huge array of topics. This research explores one clear but multifaceted aspect of The Beatles: the development of their creativity. While its importance cannot be underestimated, a thorough appraisal of the roots of the group’s individual and collective artistic blossoming deserves more attention. This paper investigates the mechanisms that caused or enabled the group to eventually exert such an immense and long-lasting influence on popular music and culture. It suggests that the artistic inspiration of Astrid Kirchherr during their time in Hamburg may be much more far-reaching than has previously been credited. It further addresses the effect of the confluence of conditions and events which essentially ‘hot-housed’ the four working-class Liverpudlians, providing them with the incentives and the means to far exceed their apparent potential. Thirdly, it looks at the competitive nature of The Beatles, both as a group and as individuals, and how that competitive streak sparked them to improve as musicians, songwriters, and showmen. In viewing these triggers through the lens of creative theory, the research attempts to analyse what made The Beatles’ innovative ascendancy so extraordinary and why creativity can be misunderstood. This then is the tale of impressionable youths from post-war austerity Britain; the lure of an artist with strong aesthetic sensibilities in an exotic locale, the media boom of the early 1960s, the machinations of the music business, the national grief in the US following Kennedy’s assassination, and, finally the resilience and determination of four young men who were prepared to take advantage of every opportunity to prove, and improve, themselves -the harbingers of a new creative paradigm. This paper is part of a broader study which also examines how their growth toward artistic maturity informs The Beatles’ significance and impact on the culture and the counterculture during the 1960s and beyond. It will eventually combine critical textual analysis with a series of interviews of musicians, other creatives, and intellectuals. These will be conducted to advance the existing erudition and to develop a more accurate understanding of the group’s cultural influence upon real-world individuals.Keywords: artistic influence, Beatles, competition, creative theory, new creative paradigm
Procedia PDF Downloads 10115 Project-Based Learning Application: Applying Systems Thinking Concepts to Assure Continuous Improvement
Authors: Kimberley Kennedy
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The major findings of this study discuss the importance of understanding and applying Systems thinking concepts to ensure an effective Project-Based Learning environment. A pilot project study of a major pedagogical change was conducted over a five year period with the goal to give students real world, hands-on learning experiences and the opportunity to apply what they had learned over the past two years of their business program. The first two weeks of the fifteen week semester utilized teaching methods of lectures, guest speakers and design thinking workshops to prepare students for the project work. For the remaining thirteen weeks of the semester, the students worked with actual business owners and clients on projects and challenges. The first three years of the five year study focused on student feedback to ensure a quality learning experience and continuous improvement process was developed. The final two years of the study, examined the conceptual understanding and perception of learning and teaching by faculty using Project-Based Learning pedagogy as compared to lectures and more traditional teaching methods was performed. Relevant literature was reviewed and data collected from program faculty participants who completed pre-and post-semester interviews and surveys over a two year period. Systems thinking concepts were applied to better understand the challenges for faculty using Project-Based Learning pedagogy as compared to more traditional teaching methods. Factors such as instructor and student fatigue, motivation, quality of work and enthusiasm were explored to better understand how to provide faculty with effective support and resources when using Project-Based Learning pedagogy as the main teaching method. This study provides value by presenting generalizable, foundational knowledge by offering suggestions for practical solutions to assure student and teacher engagement in Project-Based Learning courses.Keywords: continuous improvement, project-based learning, systems thinking, teacher engagement
Procedia PDF Downloads 11914 Effect of Dietary Fortification with Hibiscus Sabdariffa Calyces Meal on Egg Production and Egg Qualiy of Japanese Quail
Authors: Nomagugu Ndlovu, Kennedy H. Erlwanger, Eliton Chivandi
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In order to enhance egg production and egg quality from layer poultry, producers use synthetic feed additives that enhance nutrient digestion and absorption in the gut. Synthetic feed additives have negative effects on consumer health hence the need to replace them with natural alternatives which are deemed safer for consumer health. Hibiscus sabdariffa calyces meal has hypolipidemic, probiotic and antioxidant activities; hence we investigated the effect of fortifying Japanese quail pullet diets with its calyces meal on egg production and egg quality. A standard Japanese quail layer diet was supplemented with H. sabdariffa calyces meal at 0%, 5% and 10% in diets 1, 2 and 3, respectively. Ninety, 5-week old Japanese quail hens were randomly allocated to and fed the layer diets for 56 days. Body mass, feed intake and egg mass, width, length, shell mass and thickness, yolk mass, height and diameter, albumen mass, length, width and height, and the proximate content and fatty acid profile of the egg albumen and yolk were determined. Supplemental fortification of the Japanese quail layer diet with H. sabdariffa calyces meal had no effect on growth performance and feed intake and conversion rate of the quail (P>0.05). The meal delayed the onset of laying and reduced (P < 0.0001) the number of eggs laid. It did not affect the external and internal egg quality parameters of Japanese quail (P > 0.05). Dietary fortification with H. sabdariffa calyces meal at 10% significantly increased the dry matter and reduced the fat content of the yolk and albumin of Japanese quail eggs (P < 0.05). Dietary H. sabdariffa calyces meal reduced the total omega 3 fatty acids in the yolk and significantly increased arachidonic acid (P = 0.0019), an omega 6 fatty acid. Inclusion of Hibiscus sabdariffa meal depressed egg production, suppressed omega 3 fatty acids and increased arachidonic acid thus, using it as a dietary supplement may result in losses to producers of Japanese quail eggs and may result in eggs whose fatty acid profile can compromise consumer health.Keywords: quail, eggs, hibiscus sabdariffa, quality
Procedia PDF Downloads 6613 A Holistic Analysis of the Emergency Call: From in Situ Negotiation to Policy Frameworks and Back
Authors: Jo Angouri, Charlotte Kennedy, Shawnea Ting, David Rawlinson, Matthew Booker, Nigel Rees
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Ambulance services need to balance the large volume of emergency (999 in the UK) calls they receive (e.g., West Midlands Ambulance Service reports per day about 4,000 999 calls; about 679,000 calls per year are received in Wales), with dispatching limited resource for on-site intervention to the most critical cases. The process by which Emergency Medical Dispatch (EMD) decisions are made is related to risk assessment and involves the caller and call-taker as well as clinical teams negotiating risk levels on a case-by-case basis. Medical Priority Dispatch System (MPDS – also referred to as Advanced Medical Priority Dispatch System AMPDS) are used in the UK by NHS Trusts (e.,g WAST) to process and prioritise 999 calls. MPDS / AMPDS provide structured protocols for call prioritisation and call management. Protocols/policy frameworks have not been examined before in the way we propose in our project. In more detail, the risk factors that play a role in the EMD negotiation between the caller and call-taker have been analysed in both medical and social science research. Research has focused on the structural, morphological and phonological aspects that could improve, and train, human-to-human interaction or automate risk detection, as well as the medical factors that need to be captured from the caller to inform the dispatch decision. There are two significant gaps in our knowledge that we address in our work: 1. the role of backstage clinical teams in translating the caller/call-taker interaction in their internal risk negotiation and, 2. the role of policy frameworks, protocols and regulations in the framing of institutional priorities and resource allocation. We take a multi method approach and combine the analysis of 999 calls with the analysis of policy documents. We draw on interaction analysis, corpus methodologies and thematic analysis. In this paper, we report on our preliminary findings and focus in particular on the risk factors we have identified and the relationship with the regulations that create the frame within which teams operate. We close the paper with implications of our study for providing evidence-based policy intervention and recommendations for further research.Keywords: emergency (999) call, interaction analysis, discourse analysis, ambulance dispatch, medical discourse
Procedia PDF Downloads 10212 Anti-Gravity to Neo-Concretism: The Epodic Spaces of Non-Objective Art
Authors: Alexandra Kennedy
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Making use of the notion of ‘epodic spaces’ this paper presents a reconsideration of non-objective art practices, proposing alternatives to established materialist, formalist, process-based conceptualist approaches to such work. In his Neo-Concrete Manifesto (1959) Ferreira Gullar (1930-2016) sought to create a distinction between various forms of non-objective art. He distinguished the ‘geometric’ arts of neoplasticism, constructivism, and suprematism – which he described as ‘dangerously acute rationalism’ – from other non-objective practices. These alternatives, he proposed, have an expressive potential lacking in the former and this formed the basis for their categorisation as neo-concrete. Gullar prioritized the phenomenological over the rational, with an emphasis on the role of the spectator (a key concept of minimalism). Gullar highlighted the central role of sensual experience, colour and the poetic in such work. In the early twentieth century, Russian Cosmism – an esoteric philosophical movement – was highly influential on Russian avant-garde artists and can account for suprematist artists’ interest in, and approach to, planar geometry and four-dimensional space as demonstrated in the abstract paintings of Kasimir Malevich (1879-1935). Nikolai Fyodorov (1823-1903) promoted the idea of anti-gravity and cosmic space as the field for artistic activity. The artist and writer Kuzma Petrov-Vodkin (1878-1939) wrote on the concept of Euclidean space, the overcoming of such rational conceptions of space and the breaking free from the gravitational field and the earth’s sphere. These imaginary spaces, which also invoke a bodily experience, present a poetic dimension to the work of the suprematists. It is a dimension that arguably aligns more with Gullar’s formulation of his neo-concrete rather than that of his alignment of Suprematism with rationalism. While found in experiments with planar geometry, the interest in forms suggestive of an experience of breaking free–both physically from the earth and conceptually from rational, mathematical space (in a pre-occupation with non-Euclidean space and anti-geometry) and in their engagement with the spatial properties of colour, Suprematism presents itself as imaginatively epodic. The paper discusses both historical and contemporary non-objective practices in this context, drawing attention to the manner in which the category of the non-objective is used to categorise art works which are, arguably, qualitatively different.Keywords: anti-gravity, neo-concrete, non-Euclidian geometry, non-objective painting
Procedia PDF Downloads 17511 Other Cancers in Patients With Head and Neck Cancer
Authors: Kim Kennedy, Daren Gibson, Stephanie Flukes, Chandra Diwakarla, Lisa Spalding, Leanne Pilkington, Andrew Redfern
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Introduction: Head and neck cancers (HNC) are often associated with the development of non-HNC primaries, as the risk factors that predispose patients to HNC are often risk factors for other cancers. Aim: We sought to evaluate whether there was an increased risk of smoking and alcohol-related cancers and also other cancers in HNC patients and to evaluate whether there is a difference between the rates of non-HNC primaries in Aboriginal compared with non-Aboriginal HNC patients. Methods: We performed a retrospective cohort analysis of 320 HNC patients from a single center in Western Australia, identifying 80 Aboriginal and 240 non-Aboriginal patients matched on a 1:3 ratio by sites, histology, rurality, and age. We collected data on the patient characteristics, tumour features, treatments, outcomes, and past and subsequent HNCs and non-HNC primaries. Results: In the overall study population, there were 86 patients (26.9%) with a metachronous or synchronous non-HNC primary. Non-HNC primaries were actually significantly more common in the non-Aboriginal population compared with the Aboriginal population (30% vs. 17.5%, p=0.02); however, half of these were patients with cutaneous squamous or basal cell carcinomas (cSCC/BCC) only. When cSCC/BCCs were excluded, non-Aboriginal patients had a similar rate as Aboriginal patients (16.7% vs. 15%, p=0.73). There were clearly more cSCC/BCCs in non-Aboriginal patients compared with Aboriginal patients (16.7% vs. 2.5%, p=0.001) and more patients with melanoma (2.5% vs. 0%, p value not significant (p=NS). Rates of most cancers were similar between non-Aboriginal and Aboriginal patients, including prostate (2.9% vs. 3.8%), colorectal (2.9% vs. 2.5%), kidney (1.2% vs. 1.2%), and these rates appeared comparable to Australian Age Standardised Incidence Rates (ASIR) in the general community. Oesophageal cancer occurred at double the rate in Aboriginal patients (3.8%) compared with non-Aboriginal patients (1.7%), which was far in excess of ASIRs which estimated a lifetime risk of 0.59% in the general population. Interestingly lung cancer rates did not appear to be significantly increased in our cohort, with 2.5% of Aboriginal patients and 3.3% of non-Aboriginal patients having lung cancer, which is in line with ASIRs which estimates a lifetime risk of 5% (by age 85yo). Interestingly the rate of Glioma in the non-Aboriginal population was higher than the ASIR, with 0.8% of non-Aboriginal patients developing Glioma, with Australian averages predicting a 0.6% lifetime risk in the general population. As these are small numbers, this finding may well be due to chance. Unsurprisingly, second HNCs occurred at an increased incidence in our cohort, in 12.5% of Aboriginal patients and 11.2% of non-Aboriginal patients, compared to an ASIR of 17 cases per 100,000 persons, estimating a lifetime risk of 1.70%. Conclusions: Overall, 26.9% of patients had a non-HNC primary. When cSCC/BCCs were excluded, Aboriginal and non-Aboriginal patients had similar rates of non-HNC primaries, although non-Aboriginal patients had a significantly higher rate of cSCC/BCCs. Aboriginal patients had double the rate of oesophageal primaries; however, this was not statistically significant, possibly due to small case numbers.Keywords: head and neck cancer, synchronous and metachronous primaries, other primaries, Aboriginal
Procedia PDF Downloads 7210 Towards a Strategic Framework for State-Level Epistemological Functions
Authors: Mark Darius Juszczak
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While epistemology, as a sub-field of philosophy, is generally concerned with theoretical questions about the nature of knowledge, the explosion in digital media technologies has resulted in an exponential increase in the storage and transmission of human information. That increase has resulted in a particular non-linear dynamic – digital epistemological functions are radically altering how and what we know. Neither the rate of that change nor the consequences of it have been well studied or taken into account in developing state-level strategies for epistemological functions. At the current time, US Federal policy, like that of virtually all other countries, maintains, at the national state level, clearly defined boundaries between various epistemological agencies - agencies that, in one way or another, mediate the functional use of knowledge. These agencies can take the form of patent and trademark offices, national library and archive systems, departments of education, departments such as the FTC, university systems and regulations, military research systems such as DARPA, federal scientific research agencies, medical and pharmaceutical accreditation agencies, federal funding for scientific research and legislative committees and subcommittees that attempt to alter the laws that govern epistemological functions. All of these agencies are in the constant process of creating, analyzing, and regulating knowledge. Those processes are, at the most general level, epistemological functions – they act upon and define what knowledge is. At the same time, however, there are no high-level strategic epistemological directives or frameworks that define those functions. The only time in US history where a proxy state-level epistemological strategy existed was between 1961 and 1969 when the Kennedy Administration committed the United States to the Apollo program. While that program had a singular technical objective as its outcome, that objective was so technologically advanced for its day and so complex so that it required a massive redirection of state-level epistemological functions – in essence, a broad and diverse set of state-level agencies suddenly found themselves working together towards a common epistemological goal. This paper does not call for a repeat of the Apollo program. Rather, its purpose is to investigate the minimum structural requirements for a national state-level epistemological strategy in the United States. In addition, this paper also seeks to analyze how the epistemological work of the multitude of national agencies within the United States would be affected by such a high-level framework. This paper is an exploratory study of this type of framework. The primary hypothesis of the author is that such a function is possible but would require extensive re-framing and reclassification of traditional epistemological functions at the respective agency level. In much the same way that, for example, DHS (Department of Homeland Security) evolved to respond to a new type of security threat in the world for the United States, it is theorized that a lack of coordination and alignment in epistemological functions will equally result in a strategic threat to the United States.Keywords: strategic security, epistemological functions, epistemological agencies, Apollo program
Procedia PDF Downloads 769 Frequency of Tube Feeding in Aboriginal and Non-aboriginal Head and Neck Cancer Patients and the Impact on Relapse and Survival Outcomes
Authors: Kim Kennedy, Daren Gibson, Stephanie Flukes, Chandra Diwakarla, Lisa Spalding, Leanne Pilkington, Andrew Redfern
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Introduction: Head and neck cancer and treatments are known for their profound effect on nutrition and tube feeding is a common requirement to maintain nutrition. Aim: We aimed to evaluate the frequency of tube feeding in Aboriginal and non-Aboriginal patients, and to examine the relapse and survival outcomes in patients who require enteral tube feeding. Methods: We performed a retrospective cohort analysis of 320 head and neck cancer patients from a single centre in Western Australia, identifying 80 Aboriginal patients and 240 non-Aboriginal patients matched on a 1:3 ratio by site, histology, rurality, and age. Data collected included patient demographics, tumour features, treatment details, and cancer and survival outcomes. Results: Aboriginal and non-Aboriginal patients required feeding tubes at similar rates (42.5% vs 46.2% respectively), however Aboriginal patients were far more likely to fail to return to oral nutrition, with 26.3% requiring long-term tube feeding versus only 15% of non-Aboriginal patients. In the overall study population, 27.5% required short-term tube feeding, 17.8% required long-term enteral tube nutrition, and 45.3% of patients did not have a feeding tube at any point. Relapse was more common in patients who required tube feeding, with relapses in 42.1% of the patients requiring long-term tube feeding, 31.8% in those requiring a short-term tube, versus 18.9% in the ‘no tube’ group. Survival outcomes for patients who required a long-term tube were also significantly poorer when compared to patients who only required a short-term tube, or not at all. Long-term tube-requiring patients were half as likely to survive (29.8%) compared to patients requiring a short-term tube (62.5%) or no tube at all (63.5%). Patients requiring a long-term tube were twice as likely to die with active disease (59.6%) as patients with no tube (28%), or a short term tube (33%). This may suggest an increased relapse risk in patients who require long-term feeding, due to consequences of malnutrition on cancer and treatment outcomes, although may simply reflect that patients with recurrent disease were more likely to have longer-term swallowing dysfunction due to recurrent disease and salvage treatments. Interestingly long-term tube patients were also more likely to die with no active disease (10.5%) (compared with short-term tube requiring patients (4.6%), or patients with no tube (8%)), which is likely reflective of the increased mortality associated with long-term aspiration and malnutrition issues. Conclusions: Requirement for tube feeding was associated with a higher rate of cancer relapse, and in particular, long-term tube feeding was associated with a higher likelihood of dying from head and neck cancer, but also a higher risk of dying from other causes without cancer relapse. This data reflects the complex effect of head and neck cancer and its treatments on swallowing and nutrition, and ultimately, the effects of malnutrition, swallowing dysfunction, and aspiration on overall cancer and survival outcomes. Tube feeding was seen at similar rates in Aboriginal and non-Aboriginal patient, however failure to return to oral intake with a requirement for a long-term feeding tube was seen far more commonly in the Aboriginal population.Keywords: head and neck cancer, enteral tube feeding, malnutrition, survival, relapse, aboriginal patients
Procedia PDF Downloads 1018 Applicability of Polyisobutylene-Based Polyurethane Structures in Biomedical Disciplines: Some Calcification and Protein Adsorption Studies
Authors: Nihan Nugay, Nur Cicek Kekec, Kalman Toth, Turgut Nugay, Joseph P. Kennedy
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In recent years, polyurethane structures are paving the way for elastomer usage in biology, human medicine, and biomedical application areas. Polyurethanes having a combination of high oxidative and hydrolytic stability and excellent mechanical properties are focused due to enhancing the usage of PUs especially for implantable medical device application such as cardiac-assist. Currently, unique polyurethanes consisting of polyisobutylenes as soft segments and conventional hard segments, named as PIB-based PUs, are developed with precise NCO/OH stoichiometry (∽1.05) for obtaining PIB-based PUs with enhanced properties (i.e., tensile stress increased from ∽11 to ∽26 MPa and elongation from ∽350 to ∽500%). Static and dynamic mechanical properties were optimized by examining stress-strain graphs, self-organization and crystallinity (XRD) traces, rheological (DMA, creep) profiles and thermal (TGA, DSC) responses. Annealing procedure was applied for PIB-based PUs. Annealed PIB-based PU shows ∽26 MPa tensile strength, ∽500% elongation, and ∽77 Microshore hardness with excellent hydrolytic and oxidative stability. The surface characters of them were examined with AFM and contact angle measurements. Annealed PIB-based PU exhibits the higher segregation of individual segments and surface hydrophobicity thus annealing significantly enhances hydrolytic and oxidative stability by shielding carbamate bonds by inert PIB chains. According to improved surface and microstructure characters, greater efforts are focused on analyzing protein adsorption and calcification profiles. In biomedical applications especially for cardiological implantations, protein adsorption inclination on polymeric heart valves is undesirable hence protein adsorption from blood serum is followed by platelet adhesion and subsequent thrombus formation. The protein adsorption character of PIB-based PU examines by applying Bradford assay in fibrinogen and bovine serum albumin solutions. Like protein adsorption, calcium deposition on heart valves is very harmful because vascular calcification has been proposed activation of osteogenic mechanism in the vascular wall, loss of inhibitory factors, enhance bone turnover and irregularities in mineral metabolism. The calcium deposition on films are characterized by incubating samples in simulated body fluid solution and examining SEM images and XPS profiles. PIB-based PUs are significantly more resistant to hydrolytic-oxidative degradation, protein adsorption and calcium deposition than ElastEonTM E2A, a commercially available PDMS-based PU, widely used for biomedical applications.Keywords: biomedical application, calcification, polyisobutylene, polyurethane, protein adsorption
Procedia PDF Downloads 2577 Analysis of the Outcome of the Treatment of Osteoradionecrosis in Patients after Radiotherapy for Head and Neck Cancer
Authors: Petr Daniel Kovarik, Matt Kennedy, James Adams, Ajay Wilson, Andy Burns, Charles Kelly, Malcolm Jackson, Rahul Patil, Shahid Iqbal
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Introduction: Osteoradionecrosis (ORN) is a recognised toxicity of radiotherapy (RT) for head and neck cancer (HNC). Existing literature lacks any generally accepted definition and staging system for this toxicity. Objective: The objective is to analyse the outcome of the surgical and nonsurgical treatments of ORN. Material and Method: Data on 2303 patients treated for HNC with radical or adjuvant RT or RT-chemotherapy from January 2010 - December 2021 were retrospectively analysed. Median follow-up to the whole group of patients was 37 months (range 0–148 months). Results: ORN developed in 185 patients (8.1%). The location of ORN was as follows; mandible=170, maxilla=10, and extra oral cavity=5. Multiple ORNs developed in 7 patients. 5 patients with extra oral cavity ORN were excluded from treatment analysis as the management is different. In 180 patients with oral cavity ORN, median follow-up was 59 months (range 5–148 months). ORN healed in 106 patients, treatment failed in 74 patients (improving=10, stable=43, and deteriorating=21). Median healing time was 14 months (range 3-86 months). Notani staging is available in 158 patients with jaw ORN with no previous surgery to the mandible (Notani class I=56, Notani class II=27, and Notani class III=76). 28 ORN (mandible=27, maxilla=1; Notani class I=23, Notani II=3, Notani III=1) healed spontaneously with a median healing time 7 months (range 3–46 months). In 20 patients, ORN developed after dental extraction, in 1 patient in the neomandible after radical surgery as a part of the primary treatment. In 7 patients, ORN developed and spontaneously healed in irradiated bone with no previous surgical/dental intervention. Radical resection of the ORN (segmentectomy, hemi-mandibulectomy with fibula flap) was performed in 43 patients (all mandible; Notani II=1, Notani III=39, Notani class was not established in 3 patients as ORN developed in the neomandible). 27 patients healed (63%); 15 patients failed (improving=2, stable=5, deteriorating=8). The median time from resection to healing was 6 months (range 2–30 months). 109 patients (mandible=100, maxilla=9; Notani I=3, Notani II=23, Notani III=35, Notani class was not established in 9 patients as ORN developed in the maxilla/neomandible) were treated conservatively using a combination of debridement, antibiotics and Pentoclo. 50 patients healed (46%) with a median healing time 14 months (range 3–70 months), 59 patients are recorded with persistent ORN (improving=8, stable=38, deteriorating=13). Out of 109 patients treated conservatively, 13 patients were treated with Pentoclo only (all mandible; Notani I=6, Notani II=3, Notani III=3, 1 patient with neomandible). In total, 8 patients healed (61.5%), treatment failed in 5 patients (stable=4, deteriorating=1). Median healing time was 14 months (range 4–24 months). Extra orally (n=5), 3 cases of ORN were in the auditory canal and 2 in mastoid. ORN healed in one patient (auditory canal after 32 months. Treatment failed in 4 patients (improving=3, stable=1). Conclusion: The outcome of the treatment of ORN remains in general, poor. Every effort should therefore be made to minimise the risk of development of this devastating toxicity.Keywords: head and neck cancer, radiotherapy, osteoradionecrosis, treatment outcome
Procedia PDF Downloads 926 Literacy Practices in Immigrant Detention Centers: A Conceptual Exploration of Access, Resistance, and Connection
Authors: Mikel W. Cole, Stephanie M. Madison, Adam Henze
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Since 2004, the U.S. immigrant detention system has imprisoned more than five million people. President John F. Kennedy famously dubbed this country a “Nation of Immigrants.” Like many of the nation’s imagined ideals, the historical record finds its practices have never lived up to the tenets championed as defining qualities.The United Nations High Commission on Refugees argues the educational needs of people in carceral spaces, especially those in immigrant detention centers, are urgent and supported by human rights guarantees. However, there is a genuine dearth of literacy research in immigrant detention centers, compounded by a general lack of access to these spaces. Denying access to literacy education in detention centers is one way the history of xenophobic immigration policy persists. In this conceptual exploration, first-hand accounts from detained individuals, their families, and the organizations that work with them have been shared with the authors. In this paper, the authors draw on experiences, reflections, and observations from serving as volunteers to develop a conceptual framework for the ways in which literacy practices are enacted in detention centers. Literacy is an essential tool for accessing those detained in immigrant detention centers and a critical tool for those being detained to access legal and other services. One of the most striking things about the detention center is how to behave; gaining access for a visit is neither intuitive nor straightforward. The men experiencing detention are also at a disadvantage. The lack of access to their own documents is a profound barrier to men navigating the complex immigration process. Literacy is much more than a skill for gathering knowledge or accessing carceral spaces; literacy is fundamentally a source of personal empowerment. Frequently men find a way to reclaim their sense of dignity through work on their own terms by exchanging their literacy services for products or credits at the commissary. They write cards and letters for fellow detainees, read mail, and manage the exchange of information between the men and their families. In return, the men who have jobs trade items from the commissary or transfer money to the accounts of the men doing the reading, writing, and drawing. Literacy serves as a form of resistance by providing an outlet for productive work. At its core, literacy is the exchange of ideas between an author and a reader and is a primary source of human connection for individuals in carceral spaces. Father’s Day and Christmas are particularly difficult at detention centers. Men weep when speaking about their children and the overwhelming hopelessness they feel by being separated from them. Yet card-writing campaigns have provided these men with words of encouragement as thousands of hand-written cards make their way to the detention center. There are undoubtedly more literacies being practiced in the immigrant detention center where we work and at other detention centers across the country, and these categories are early conceptions with which we are still wrestling.Keywords: detention centers, education, immigration, literacy
Procedia PDF Downloads 1275 Choosing Mountains Over the Beach: Evaluating the Effect of Altitude on Covid Brain Severity and Treatment
Authors: Kennedy Zinn, Chris Anderson
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Chronic Covid syndrome (CCS) is a condition in which individuals who test positive for Covid-19 experience persistent symptoms after recovering from the virus. CCS affects every organ system, including the central nervous system. Neurological “long-haul” symptoms last from a few weeks to several months and include brain fog, chronic fatigue, dyspnea, mood dysregulation, and headaches. Data suggest that 10-30% of individuals testing positive for Covid-19 develop CCS. Current literature indicates a decreased quality of life in persistent symptoms. CCS is a pervasive and pernicious COVID-19 sequelae. More research is needed to understand risk factors, impact, and possible interventions. Research frequently cites cytokine storming as noteworthy etiology in CCS. Cytokine storming is a malfunctional immune response and facilitates multidimensional interconnected physiological responses. The most prominent responses include abnormal blood flow, hypoxia/hypoxemia, inflammation, and endothelial damage. Neurological impairments and pathogenesis in CCS parallel that of traumatic brain injury (TBI). Both exhibit impairments in memory, cognition, mood, sustained attention, and chronic fatigue. Evidence suggests abnormal blood flow, inflammation, and hypoxemia as shared causal factors. Cytokine storming is also typical in mTBI. The shared characteristics in symptoms and etiology suggest potential parallel routes of investigation that allow for better understanding of CCS. Research on the effect of altitude in mTBI varies. Literature finds decreased rates of concussions at higher altitudes. Other studies suggest that at a higher altitude, pre-existing mTBI symptoms are exacerbated. This may mean that in CCS, the geographical location where individuals live and the location where individuals experienced acute Covid-19 symptoms may influence the severity and risk of developing CCS. It also suggests that clinics which treat mTBI patients could also provide benefits for those with CCS. This study aims to examine the relationships between altitude and CCS as a risk factor and investigate the longevity and severity of symptoms in different altitudes. Existing patient data from a concussion clinic using fMRI scans and self-reported symptoms will be used for approximately 30 individuals with CCS symptoms. The association between acclimated altitude and CCS severity will be analyzed. Patients will be classified into low, medium, and high altitude groups and compared for differences on fMRI severity scores and self-reported measures. It is anticipated that individuals living in lower altitudes are at higher risk of developing more severe neuropsychological symptoms in CCS. It is also anticipated that a treatment approach for mTBI will also be beneficial to those with CCS.Keywords: altitude, chronic covid syndrome, concussion, covid brain, EPIC treatment, fMRI, traumatic brain injury
Procedia PDF Downloads 132